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The preparation of this article was supported in part by Grant PSI2009-08132 from the Spanish Ministry of Science and Innovation and Grant PSI2012-31293 from the Spanish Ministry of Economy and Competitiveness. We thank all the caregivers for their participation in the study and also the following centers for collaborating with us in the project: Fundacion Cien, Fundacion Maria Wolff, Centros de dia Vitalia, Centro de Salud General Ricardos, Centro de Salud Garcia Noblejas, Centro de Salud Benita de Avila, Centro de Salud Vicente Muzas, Centro Reina Sofia de Cruz Roja, Unidad de Memoria de Cantoblanco, Servicio de Neurologia del Hospital La Paz, Asociacion de Familiares de Alzheimer de Alcorcon, Instituto de Familia de la Universidad CEU San Pablo, Centro de Psicologia Aplicada de la Universidad Autonoma de Madrid, and Servicios Sociales de Getafe.

Analysis of institutional authors

Losada, ACorresponding AuthorRomero-Moreno, RAuthorNogales-Gonzalez, CAuthor

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September 27, 2022
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Cognitive-Behavioral Therapy (CBT) Versus Acceptance and Commitment Therapy (ACT) for Dementia Family Caregivers With Significant Depressive Symptoms: Results of a Randomized Clinical Trial

Publicated to:Journal Of Consulting And Clinical Psychology. 83 (4): 760-772 - 2015-08-01 83(4), DOI: 10.1037/ccp0000028

Authors: Losada, Andres; Marquez-Gonzalez, Maria; Romero-Moreno, Rosa; Mausbach, Brent T; Lopez, Javier; Fernandez-Fernandez, Virginia; Nogales-Gonzalez, Celia

Affiliations

Univ Autonoma Madrid, Dept Biol & Clin Psychol, E-28049 Madrid, Spain - Author
Univ Calif San Diego, Dept Psychiat, San Diego, CA 92103 USA - Author
Univ CEU San Pablo, Dept Psychol, Madrid, Spain - Author
Univ Rey Juan Carlos, Dept Psychol, Alcorcon 28922, Spain - Author

Abstract

Objective: The differential efficacy of acceptance and commitment therapy (ACT) and cognitive-behavioral therapy (CBT) for dementia family caregivers' is analyzed through a randomized controlled trial. Method: Participants were 135 caregivers with high depressive symptomatology who were randomly allocated to the intervention conditions or a control group (CG). Pre-, postintervention, and follow-up measurements assessed depressive symptomatology, anxiety, leisure, dysfunctional thoughts, and experiential avoidance. Results: Depression: Significant effects of interventions compared with CG were found for CBT (p < .001, d = 0.98, number needed to treat [NNT] = 3.61) and ACT (p < .001, d = 1.17, NNT = 3.53) at postintervention, but were maintained only at follow-up for CBT (p = .02, d = 0.74, NNT = 9.71). Clinically significant change was observed in 26.7% participants in CBT, 24.2% in ACT, and 0% in CG. At follow-up, 10.53% in CBT and 4% in ACT were recovered (0% CG). Anxiety: At postintervention, ACT participants showed lower anxiety than CBT participants (p < .05, d = 0.50) and CG participants (p < .01, d = 0.79, NNT = 3.86), with no effects at follow-up. At postintervention, 23.33% in CBT, 36.36% in ACT, and 6.45% in CG showed clinically significant change. At follow-up, 26.32% in CBT, 36% in ACT, and 13.64% in CG were recovered. Significant changes at postintervention were found in leisure and dysfunctional thoughts in both ACT and CBT, with changes in experiential avoidance only for ACT. Conclusion: Similar results were obtained for ACT and CBT. ACT seems to be a viable and effective treatment for dementia caregivers.

Keywords

Acceptance and commitment therapyAdultAgedAnxietyArticleAvoidance behaviorCaregiverCaregiversCognitive therapyCognitive- behavioral therapyCognitive-behavioral therapyControlled studyDementiaDepressionDepressive disorder, majorDisordersDistressEffect sizeExperiential avoidanceFemaleFollow upFunctional statusHumanHumansInterventionInterventionsLeisureMajor clinical studyMaleMiddle agedNumbers needed to treatNursingOlderOutcomesPhysical healthPsychologyRandomized controlled trialRecommendationsSymptomatologyThinkingTreatment outcomeValidation

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal Of Consulting And Clinical Psychology due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2015, it was in position 9/122, thus managing to position itself as a Q1 (Primer Cuartil), in the category Psychology, Clinical.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 5.96. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

  • Weighted Average of Normalized Impact by the Scopus agency: 7.04 (source consulted: FECYT Feb 2024)
  • Field Citation Ratio (FCR) from Dimensions: 44.15 (source consulted: Dimensions Jul 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-07-05, the following number of citations:

  • WoS: 183
  • Scopus: 195

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-07-05:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 443.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 443 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 7.5.
  • The number of mentions on the social network Facebook: 3 (Altmetric).
  • The number of mentions on the social network X (formerly Twitter): 6 (Altmetric).

Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: United States of America.

There is a significant leadership presence as some of the institution’s authors appear as the first or last signer, detailed as follows: First Author (Losada Baltar, Andrés) and Last Author (Nogales González, Celia).

the author responsible for correspondence tasks has been Losada Baltar, Andrés.